Abstract
Women with absolute uterine-factor infertility (AUFI) had until recently only the opportunity to have children through adoption, foster parenting, or gestational surrogacy. However, for some women with AUFI, none of these options is possible due to religious, societal, personal, or other reasons.
Uterus transplantation (UTx) has recently been introduced as a unique opportunity for both, genetic and gestational motherhood. To date, most UTx were accomplished with uterus transplants procured from living donors.
Although deceased donor (DD) UTx have been performed successfully, the overall experience remains rare. Notably, most (10/13) DD UTx have been performed by the teams in Dallas, Tx, USA and Prague, Czech Republic.
Recently, the first baby was born to a recipient after DD UTx in São Paulo1 demonstrating a proof of concept for DD UTx. DD UTx is desirable as it i) avoids risks associated with complex live donor hysterectomies, and ii), not every patient in need may have a qualifying living donor available.
Thus, it appears critical to analyze the potential of DD UTx. Several unknowns and limitations to this pursuit need to be addressed and include, i), the lack of standardized evaluation criteria of uterus DD (both standard and extended criteria), ii), information on the availability of potential uterus DDs, iii), assuring that potential donors will be identified by organ procurement organizations (OPOs), and, iv), issues of consent beyond that taken for the procurement of solid organs for transplantation Here, we address those issues in a transatlantic approach with an analysis in the Czech Republic, Sweden, the UK, and the USA (Fig 1).
We aimed to roughly approximate the volume of potential uterus donors, demand for transplantation linked to geographical region. Moreover, we suggest criteria allowing OPOs to identify uterus DD and introduce the experience at our institutions on getting consent.
Our analysis was based on data (collected from 2012 to 2016) provided directly from the respective national bodies dealing with organ allocation, i.e., the Coordination Center of Transplantation (Czech Republic),2 Scandiatransplant (Sweden),3 National Health Service Blood and Transplant (United Kingdom),4 and the United Network for Organ Sharing (USA)5. Notably, data of the National Health Service are collected per fiscal years.
To estimate the uterus DD population/country, data on total donor volume/year and female brain death (DBD) donors 20-45 years were collected. Data on overall population were provided by Eurostat (for the Czech Republic, Sweden, and the UK) and the World Bank (for the USA).6,7 Female DDs were calculated per million people (PMP) of total population.
Additional information of relevance for uterus donation (gynecological history, malignancies, Pap smears, parity, and gynecological surgery [particularly cesarean section]) was requested by the OPOs. Moreover, we collected information whether the next of kin's authorization to uterus recovery was requested, and whether the question on authorization to uterus recovery is present in a DD registry.